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Welcome: Risk Assessment and Compliance Toolkit

Risk Assessment and Compliance Toolkit for Group Health Plans

Welcome! This questionnaire will generate an approximate compliance percentage based on a snapshot of our Compliance and Risk Assessment Toolkit for group health plans. Once you’ve completed this survey, a team member will contact you to review the outcome and discuss steps toward compliance.

By partnering with us, employers reach 100% compliance with our ease-of-use materials, hands-on assistance and ongoing compliance maintenance. 

Scale Point Values

  • 100% - In Great Shape!
    • Confident of our compliance and have procedures in place for ensuring ongoing compliance and recordkeeping.
  • 90% to 99% - In Good Shape!
    • Confident of our compliance and have the resources to maintain compliance.
  • 60% to 89% - Action Steps Needed!
    • Compliant, but have not taken additional steps to ensure ongoing recordkeeping and compliance. We need support in this area.
  • 50% to 59% - Compliance Assistance Needed!
    • Unsure of compliance and considering options for additional support.
  • 20% to 49% - Compliance Assistance Needed!
    • Represents a concern for our organization, yet not informed or prepared to address without assistance
  • Below 20% - Not Compliant!
    • Represents a concern for our organization at multiple levels of management. We need immediate compliance direction.

Employee Benefits Inventory

Do you offer a group health plan?

For the health plan, provide the carrier name and the renewal date

Do you offer dental?

For the dental, please provide the carrier name and the renewal date

Do you offer vision?

For the vision, please provide the carrier name and the renewal date

Do you offer employer sponsored life insurance?

For the life insurance, please provide the carrier name and the renewal date

Do you offer short-term disability?

For the short-term disability, please provide the carrier name and the renewal date

Do you offer long-term disability?

For the long-term disability, please provide the carrier name and renewal date

Do you offer critical illness?

For the critical illness, please provide the carrier name and renewal date

Do you offer accidental death and dismemberment insurance?

For the death and dismemberment insurance, please provide the carrier name and renewal date

Do you have a 401(k) plan?

Do you have a fidelity bond for your 401(k) plan?

Do you self-administer or use a third-party to administer FMLA?

If you use a third-party administer, who is it?

Required Notices and Disclosures

How confident are you that your organization distributes required benefit notices?

How confident are you that your organization distributes the Women’s Health and Cancer Rights Act (WHCRA) Notice?

How confident are you that your organization distributes the Newborns’ and Mothers’ Health Protection Act (NMHPA) Notice?

How confident are you that your organization distributes the Employer Medicaid and Children's Health Insurance Program (CHIP) Eligibility Notice annually to all employees in qualifying states?

How confident are you that your organization complies with the rules of the Mental Health Parity and Addiction Equity Act (MHPAEA) Act?

How confident are you that your organization provides a Marketplace (Exchange) Notice to all employees, regardless of plan eligibility within 14 days of hire?

How confident are you that your organization is prepared to comply with The Consolidated Appropriations Act, 2021 amended MHPAEA? The CAA requires all applicable health plans to keep detailed analysis at all times on how their plans meet the Non-Quantitative Treatment Limitations (NQTLs) requirements. Also referred to as a comparative analysis and documentation regarding quantified plan limits.

Consolidated Omnibus Reconciliation Act (COBRA)

How confident are you that the required notices are sent to eligible employees from the TPA/ COBRA administrator within 90 days of initial enrollment and within 30 days of a qualifying event?

How confident are you that you are informing former employees and beneficiaries of rights of portability or conversion of benefits upon termination?

Family Medical Leave (FMLA)

Are you an employer who is required to offer FMLA?

Are general notices posted/displayed for employees to view and/or made available to remote workers?

Are you aware of Paid Family Leave, insurance requirements and reporting requirements in other states where you may conduct business?

Medicare Part D Notice to Eligible Participants and Reporting Requirements

How confident are you that your organization distributes the notice of Creditable or Non-creditable prescription drug coverage annually to eligible individuals (both employees & retirees eligible for Medicare) before October 14th?

How confident are you that your organization has a process in place to annually report the creditable or non-creditable prescription drug coverage status for your plans on the CMS website?

Plan Document Requirements

A Summary Plan Description (SPD) or WRAP document does NOT come from your carrier. How confident are you that your organization has Summary Plan Description(s) or a WRAP document per ERISA rules?

How confident are you that new hires in your organization receive an SPD within 90 days of plan participation?

How confident are you that the Summary of Material Modification (SMM) has been added to the SPD/WRAP document as they relate to new legislation? This includes but is not limited to; COVID-19 Testing.

How confident are you that your organization has a process established to provide the uniform Summary of Benefits and Coverage (SBC) to participants and beneficiaries?

Is corporate counsel or a law firm resource accessible for specialized assistance in combining plan documents?

Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security Policy & Procedure Compliance (HITECH)

Has a HIPAA policy and procedure manual been documented and maintained for your organization?

Has a HIPAA privacy officer been established & documented for your organization?

Have members of the covered entity’s workforce (i.e., plan sponsor’s workforce working with PHI) been formally trained?

FSA, HSA, DCAP and Spousal Conditions

Have FSA, HSA and DCAP increased contribution limits been vetted for your organization?

Has your organization had a strategic discussion regarding including a spousal carve-out, surcharges and/or spousal and dependent affidavits?

Plan Strategies and Reporting Requirements

Do you file a Form 5500 for ERISA benefit plan(s) with 100 or more participants?

Are you informed of the potential penalty exposure for noncompliance with ERISA requirements for group health plans?

Are you confident of your Applicable Large Employer (ALE) status and comply with Employer Shared Responsibility?

Within your organization, have employee classifications (e.g., full-time, part-time, variable-hour employees) been determined for purposes of identifying the proper code (“code for the offer and coverage”) to include on the IRS forms 1094 & 1095 reporting?

Are you confident that you comply with the ACA Employer Reporting requirements to the IRS?

How confident are you that your organization has structured practical steps to deliver required forms and/or notices to employees?

How confident are you that electronic communications options are available to employees? (Note that electronic communication options are available if within the ERISA electronic communication safe harbors, i.e., intranet systems for employees with access to computers within their customary work duties):

As an employer sponsoring a health and welfare plan(s), are you aware of the employee benefit provisions in The Consolidated Appropriations Act? These include the No Surprises Act, Rx Data Reporting, Gag Clause Attestation and Transparency Disclosure Provisions.

Miscellaneous

How confident are you that your organization has a recordkeeping process in place in the event of a DOL audit?

How confident are you that you have policies and procedures in place relating to a pandemic crisis? Employee handbooks should include COVID-19 policies, vaccination and or surcharge guidelines, remote work, return to work, paid sick leave and FMLA policies.

Your Contact Information

Name*
What Industry are you in?*
How is your benefits program structured?*
Number of Insurable Lives?*
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